Philips Medicaid Billing Rep in Framingham, Massachusetts

JOB RESPONSIBILITIES

  • Utilize monthly aging accounts receivable reports to follow up on unpaid claims aged over 30 days, filing appeals when appropriate to obtain maximum reimbursement and establish and maintain strong relationships with all stakeholders.

  • Obtain authorizations for services and enter authorization, insurance, and demographics accurately and timely.

  • Accurate and timely entry of CPT and diagnosis codes and the relevant authorizations to ensure clean claims are released.

  • Communicate proactively of billing issues.

  • Ensure all claims are submitted with a goal of zero errors.

  • Verify completeness and accuracy of all claims prior to submission.

  • Timely follow up on insurance claim denials, exceptions or exclusions.

  • Read and interpret insurance explanation of benefits.

  • Respond to inquiries from case managers, insurance companies, patients and providers and internal customers such as sales.

  • Regularly attend monthly staff meetings and continuing educational sessions as requested.

  • Perform additional duties and projects as requested.

REQUIRED SKILLS & QUALIFICATIONS:

  • Education Requirements: High School Diploma, or equivalent. Associates Degree in Medical Billing and Coding or Accounting, preferred. Two years of experience in lieu of education may also be considered.

  • Years of Experience/Training: Minimum of 2- 5 years of experience in medical billing, preferably with Medicaid and Managed Care reimbursement.

  • Computer experience is essential. Must be technically savvy and comfortable using software, including, but not limited to: billing software, MS Office, Insurance Portals, and Electronic Claims Submissions. High aptitude to learn new programs, system integrations, and business processes.

  • Experience in CPT and ICD-10 coding; familiarity with medical terminology.

  • Excellent customer service skills.

  • Strong written and verbal communication skills.

  • Ability to manage relationships with various Insurance payers.

  • Experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursement.

  • Ability to multi-task and work courteously and respectfully with fellow employees, clients and patients.

  • Strong work ethic with proven track record of accuracy, dependability and consistency

  • Must be able to think independently, have strong problem solving skills, and have a continuous improvement mentality.

  • Team player, ability to gain the cooperation of others in pursuit of company goals.

WORK ENVIRONMENT

This job operates in an office setting, sharing a large room with other employees. As a result, the work area can be crowded and/or noisy. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, fax machines, and other similar items.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential job functions of this job.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit, stand; walk; use hands to finger, hand or feel; and reach with hands and arms.

In this role, you have the opportunity to

Perform in a medical biller position which is in a dynamic and fast paced environment where you will use your medical billing, collecting knowledge and experience to obtain maximum reimbursement, establishing strong relationships with insurance companies and customers.

Shift: Monday thru Friday 8:30am to 5pm

You are responsible for

  • Obtain and enter authorizations, insurance and demographic information accurately and timely to ensure clean claims are released

  • Communicate proactively of any billing issues identified

  • Timely follow-up on insurance claim denials and exceptions

  • Read and interpret insurance explanation of benefits

  • Respond to inquiries from Case Managers, insurance companies, and internal customers in a timely manner

  • Regularly attend monthly staff meetings and in-house training

You are a part of

A culture of collaboration and team building is embraced. You will be recognized for your individual achievements as well as your contribution to the team dynamic.

To succeed in this role, you should have the following skills and experience

  • Education Requirements: High School Diploma, or equivalent. Associates Degree in Medical Billing and Coding or Accounting, preferred. Two years of experience in lieu of education may also be considered.

  • Years of Experience/Training: Minimum of 2- 5 years of experience in medical billing, preferably with Medicaid and Managed Care reimbursement.

  • Computer experience is essential. Must be technically savvy and comfortable using software, including, but not limited to: billing software, MS Office, Insurance Portals, and Electronic Claims Submissions. High aptitude to learn new programs, system integrations, and business processes.

  • Experience in CPT and ICD-10 coding; familiarity with medical terminology.

  • Excellent customer service skills.

  • Strong written and verbal communication skills.

  • Ability to manage relationships with various Insurance payers.

  • Experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursement.

  • Ability to multi-task and work courteously and respectfully with fellow employees, clients and patients.

  • Strong work ethic with proven track record of accuracy, dependability and consistency

  • Must be able to think independently, have strong problem solving skills, and have a continuous improvement mentality.

  • Team player, ability to gain the cooperation of others in pursuit of company goals.·

In return, we offer you

An opportunity to work for a company, Philips Lifeline that provides a service for many that enables them to have emergency help either from their phone or at home.

Why should you join Philips?

Working at Philips is more than a job. It’s a calling to create a healthier society through meaningful work, focused on improving 3 billion lives a year by delivering innovative solutions across the health continuum at http://www.philips.com/b-dam/corporate/corporateblog/2016/PhilipsChronicDisease_5.jpg . Our people experience a variety of unexpected moments when their lives and careers come together in meaningful ways.

To find out more about what it’s like working for Philips at a personal level, visit the Working at Philips page at http://www.philips.com/a-w/careers/healthtech/working-at-philips/working-at-philips.html on our career website, where you can read stories from our employee blog at http://www.usa.philips.com/a-w/our-people/life-at-philips.html . Once there, you can also learn about our recruitment process at http://www.philips.com/a-w/careers/healthtech.html , or find answers to some of the frequently asked questions at http://www.philips.com/a-w/careers/healthtech/faq.html .

Philips is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex (including pregnancy), sexual orientation, gender identity, national origin, genetic information, creed, citizenship, disability, protected veteran or marital status.

As an equal opportunity employer, Philips is committed to a diverse workforce. In order to ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veterans' Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants that require accommodation in the job application process may contact 888-367-7223, option 5, for assistance.

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